Spinal implant system and method

ABSTRACT

A spinal implant comprises an implant body extending between an anterior surface and a posterior surface. The implant body includes a first vertebral engaging surface and a second vertebral engaging surface. The implant body includes an outer surface that defines an oblique surface. A wall is connectable with the implant body and translatable relative to the oblique surface. Systems and methods are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to aspinal implant system and a method for treating a spine.

BACKGROUND

Spinal pathologies and disorders such as scoliosis and other curvatureabnormalities, kyphosis, degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, tumor, and fracture mayresult from factors including trauma, disease and degenerativeconditions caused by injury and aging. Spinal disorders typically resultin symptoms including deformity, pain, nerve damage, and partial orcomplete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, may fail to relieve the symptoms associatedwith these disorders. Surgical treatment of these spinal disordersincludes fusion, fixation, correction, discectomy, laminectomy andimplantable prosthetics. As part of these surgical treatments, spinalconstructs, such as, for example, bone fasteners, spinal rods andinterbody devices can be used to provide stability to a treated region.For example, during surgical treatment, surgical instruments can be usedto deliver components of the spinal constructs to the surgical site forfixation with bone to immobilize a joint. Certain spinal surgeryapproaches utilize a direct lateral approach to access intervertebralspaces, however, these techniques present certain challenges due to thelocation of musculature and neural structures embedded therein.

This disclosure describes an improvement over these prior arttechnologies with the provision of specialized instrumentation, implantsand techniques to allow for an oblique lateral surgical pathway to theintervertebral spaces.

SUMMARY

A spinal implant comprises an implant body extending between an anteriorsurface and a posterior surface. The implant body includes a firstvertebral engaging surface and a second vertebral engaging surface. Theimplant body includes an outer surface that defines an oblique surface.A wall or plate is connectable with the implant body and translatablerelative to the oblique surface.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more readily apparent from thespecific description accompanied by the following drawings, in which:

FIG. 1 is a perspective view of components of one embodiment of a systemin accordance with the principles of the present disclosure;

FIG. 2 is a cross section view of the components of the system shown inFIG. 1;

FIG. 3 is an end view of components of the system shown in in FIG. 2;

FIG. 4 is a cross section view of components of one embodiment of asystem in accordance with the principles of the present disclosure;

FIG. 5 is an end view taken along lines A-A of components shown in FIG.4;

FIG. 6 is a side cross section view taken along lines B-B of componentsshown in FIG. 5;

FIG. 7 is a perspective view of components of one embodiment of a systemin accordance with the principles of the present disclosure;

FIG. 8 is a perspective view of the components shown in FIG. 7;

FIG. 9 is a perspective view of the components shown in FIG. 7;

FIG. 10 is a perspective view of components of one embodiment of asystem in accordance with the principles of the present disclosuredisposed with vertebrae;

FIG. 11 is a plan view of the components and vertebrae shown in FIG. 10;

FIG. 12 is a plan view of the components and vertebrae shown in FIG. 10;

FIG. 13 is a plan view of the components and vertebrae shown in FIG. 10;

FIG. 14 is a perspective view of components and vertebrae shown in FIG.10;

FIG. 15 is a perspective view of the components and vertebrae shown inFIG. 14;

FIG. 16 is a perspective view of the components and vertebrae shown inFIG. 14;

FIG. 17 is a perspective view of components of one embodiment of asystem in accordance with the principles of the present disclosuredisposed with vertebrae;

FIG. 18 is a perspective view of the components and vertebrae shown inFIG. 17;

FIG. 19 is a plan view of the components and vertebrae shown in FIG. 17;

FIG. 20 is a perspective view of the components and vertebrae shown inFIG. 17;

FIG. 21 is a plan view of components and vertebrae shown in FIG. 17;

FIG. 22 is a plan view of the components and vertebrae shown in FIG. 17;

FIG. 23 is a plan view of components of one embodiment of a system inaccordance with the principles of the present disclosure;

FIG. 24 is a side view of the components shown in FIG. 23;

FIG. 25 is a plan view of components of one embodiment of a system inaccordance with the principles of the present disclosure;

FIG. 26 is a side view of components of one embodiment of a system inaccordance with the principles of the present disclosure;

FIG. 27 is a plan view of components shown in FIG. 26 disposed withvertebrae;

FIGS. 28A-28D are views of components of one embodiment of a multi-leveland connectable system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 29 is a side view of components of one embodiment of a system inaccordance with the principles of the present disclosure disposed withvertebrae;

FIG. 30 is a side view of the components and vertebrae shown in FIG. 29;

FIGS. 31A-31B are views of components of one embodiment of a system inaccordance with the principles of the present disclosure in an unlockedlow or zero-profile position; and

FIG. 32A-32B are views of components shown in FIGS. 31A-31B in a lockedtransverse position.

DETAILED DESCRIPTION

The exemplary embodiments of the surgical system and related methods ofuse disclosed are discussed in terms of medical devices for thetreatment of musculoskeletal disorders and more particularly, in termsof a surgical system for implant delivery to a surgical site and amethod for treating a spine, which employ an oblique surgical pathway,which may include an oblique-lateral surgical pathway. In oneembodiment, the systems and methods of the present disclosure areemployed with a spinal joint and fusion, for example, with a cervical,thoracic, lumbar and/or sacral region of a spine.

In one embodiment, the surgical system includes an interbody implanthaving an integral floating plate utilized with oblique lateralinterbody fusion (OLIF) and direct lateral interbody fusion (DLIF)procedures. In one embodiment, the surgical system includes a standaloneinterbody implant and a standalone plate configured for connection witheach other. In some embodiments, the interbody implant is inserted andmoved off oblique into a lateral position and the plate is maintained inthe oblique surgical pathway facilitating engagement of screws withvertebrae. In one embodiment, the surgical system includes an interbodyimplant having a track disposed along an oblique surface of theinterbody implant. In one embodiment, the surgical system includes aplate configured for rotation relative to the interbody implant suchthat a flush or low profile configuration is maintained duringinsertion. In some embodiments, the plate is configured for rotation intwo or more planes such that the plate rotates about a longitudinal axisof the interbody implant. In one embodiment, the plate is configured forrotation about an axis defined by a proximal end of the interbodyimplant such that the plate rotates into the implant to reduce theprofile of the surgical system upon insertion.

In one embodiment, the surgical system includes an interbody implanthaving a plate freely translatable relative to the interbody implantalong an elongated opening, such as, for example, a track. In oneembodiment, the surgical system includes an interbody implant having aplate configured to be locked with the interbody implant. In oneembodiment, the plate includes a plurality of openings configured toreceive fasteners. In one embodiment, the surgical system includes boltsand/or nuts to facilitate translation of the plate relative to theinterbody implant. In one embodiment, the surgical system includesfasteners configured to engage the plate in a straight and/or angledconfiguration.

In one embodiment, the surgical system includes an interbody implanthaving a plate attached along an oblique surface of the interbodyimplant. In one embodiment, the surgical system includes an interbodyimplant having a plate attached along an anterior surface of theinterbody implant. In one embodiment, the surgical system includes aninterbody implant having a multi-level plate configuration such thatsingle level plates are linked together via an additional plate andlocked together. In one embodiment, the surgical system includes aninterbody implant having an x-shaped plate configuration such that twoseparate plates can be inserted in a stacked configuration and rotatedand fixed with vertebrae in an x-shaped configuration. In oneembodiment, each plate includes a threaded post configured to facilitateattachment of the plates. In some embodiments, the plates are configuredto nest within one another to reduce the plate profile. In oneembodiment, the plates can be inserted individually into the surgicalsite.

In one embodiment, the surgical system includes an interbody implantincluding a track having a constant radii configured to receive a plate.In one embodiment, the surgical system includes an interbody implantincluding a track having a variable radii configured to receive a plate.

The present disclosure may be understood more readily by reference tothe following detailed description of the embodiments taken inconnection with the accompanying drawing figures, which form a part ofthis disclosure. It is to be understood that this application is notlimited to the specific devices, methods, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting. Also, as used in thespecification and including the appended claims, the singular forms “a,”“an,” and “the” include the plural, and reference to a particularnumerical value includes at least that particular value, unless thecontext clearly dictates otherwise. Ranges may be expressed herein asfrom “about” or “approximately” one particular value and/or to “about”or “approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”.

Further, as used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs to apatient (human, normal or otherwise or other mammal), employingimplantable devices, and/or employing instruments that treat thedisease, such as, for example, microdiscectomy instruments used toremove portions bulging or herniated discs and/or bone spurs, in aneffort to alleviate signs or symptoms of the disease or condition.Alleviation can occur prior to signs or symptoms of the disease orcondition appearing, as well as after their appearance. Thus, treatingor treatment includes preventing or prevention of disease or undesirablecondition (e.g., preventing the disease from occurring in a patient, whomay be predisposed to the disease but has not yet been diagnosed ashaving it). In addition, treating or treatment does not require completealleviation of signs or symptoms, does not require a cure, andspecifically includes procedures that have only a marginal effect on thepatient. Treatment can include inhibiting the disease, e.g., arrestingits development, or relieving the disease, e.g., causing regression ofthe disease. For example, treatment can include reducing acute orchronic inflammation; alleviating pain and mitigating and inducingre-growth of new ligament, bone and other tissues; as an adjunct insurgery; and/or any repair procedure. Also, as used in the specificationand including the appended claims, the term “tissue” includes softtissue, ligaments, tendons, cartilage and/or bone unless specificallyreferred to otherwise.

The following discussion includes a description of a surgical system andrelated methods of employing the surgical system in accordance with theprinciples of the present disclosure. Alternate embodiments are alsodisclosed. Reference is made in detail to the exemplary embodiments ofthe present disclosure, which are illustrated in the accompanyingfigures. Turning to FIGS. 1-22, there are illustrated components of asurgical system, such as, for example, a spinal implant system 10.

The components of spinal implant system 10 can be fabricated frombiologically acceptable materials suitable for medical applications,including metals, synthetic polymers, ceramics and bone material and/ortheir composites, depending on the particular application and/orpreference of a medical practitioner. For example, the components ofspinal implant system 10, individually or collectively, can befabricated from materials such as stainless steel alloys, commerciallypure titanium, titanium alloys, Grade 5 titanium, super-elastic titaniumalloys, cobalt-chrome alloys, stainless steel alloys, superelasticmetallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUMMETAL® manufactured by Toyota Material Incorporated of Japan), ceramicsand composites thereof such as calcium phosphate (e.g., SKELITE™manufactured by Biologix Inc.), thermoplastics such aspolyaryletherketone (PAEK) including polyetheretherketone (PEEK),polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEKcomposites, PEEK-BaSO₄ polymeric rubbers, polyethylene terephthalate(PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers,polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigidmaterials, elastomers, rubbers, thermoplastic elastomers, thermosetelastomers, elastomeric composites, rigid polymers includingpolyphenylene, polyamide, polyimide, polyetherimide, polyethylene,epoxy, bone material including autograft, allograft, xenograft ortransgenic cortical and/or corticocancellous bone, and tissue growth ordifferentiation factors, partially resorbable materials, such as, forexample, composites of metals and calcium-based ceramics, composites ofPEEK and calcium based ceramics, composites of PEEK with resorbablepolymers, totally resorbable materials, such as, for example, calciumbased ceramics such as calcium phosphate such as hydroxyapatite (HA),corraline HA, biphasic calcium phosphate, tricalcium phosphate, orfluorapatite, tri-calcium phosphate (TCP), HA-TCP, calcium sulfate, orother resorbable polymers such as polyaetide, polyglycolide,polytyrosine carbonate, polycaroplaetohe and their combinations,biocompatible ceramics, mineralized collagen, bioactive glasses, porousmetals, bone particles, bone fibers, morselized bone chips, bonemorphogenetic proteins (BMP), such as BMP-2, BMP-4, BMP-7, rhBMP-2, orrhBMP-7, demineralized bone matrix (DBM), transforming growth factors(TGF, e.g., TGF-β), osteoblast cells, growth and differentiation factor(GDF), insulin-like growth factor 1, platelet-derived growth factor,fibroblast growth factor, or any combination thereof.

Various components of spinal implant system 10 may have materialcomposites, including the above materials, to achieve various desiredcharacteristics such as strength, rigidity, elasticity, compliance,biomechanical performance, durability and radiolucency or imagingpreference. The components of spinal implant system 10, individually orcollectively, may also be fabricated from a heterogeneous material suchas a combination of two or more of the above-described materials. Thecomponents of spinal implant system 10 may be monolithically formed,integrally connected or include fastening elements and/or instruments,as described herein.

Spinal implant system 10 is employed, for example, with a fully opensurgical procedure, a minimally invasive procedure, includingpercutaneous techniques, and mini-open surgical techniques to deliverand introduce instrumentation and/or an implant, such as, for example,an interbody implant, at a surgical site of a patient, which includes,for example, a spine having vertebrae V, as shown in FIGS. 11-22. Insome embodiments, a surgical pathway P to a surgical site is formed viaan OLIF or DLIF procedure. In some embodiments, the implant can includespinal constructs, such as, for example, bone fasteners, spinal rods,connectors and/or plates.

Spinal implant system 10 includes an implant body, such as, for example,an interbody cage 12, as shown in FIG. 1. Cage 12 extends between aposterior surface 14 and an anterior surface 16 and defines alongitudinal axis L1. Posterior surface 14 is configured to face aposterior side of a patient body and be disposed adjacent an anteriorportion of vertebrae, such as, for example a posterior portion P1 of oneor more intervertebral spaces of vertebrae V, as shown in FIG. 11.Anterior surface 16 is configured to face an anterior side of thepatient body and be disposed adjacent an anterior portion of vertebrae,such as, for example an anterior portion A1 of one or moreintervertebral spaces of vertebrae V, as shown in FIG. 11.

In the various embodiments described herein, cage 12 (and analogouscages described with respect to the various figures) may be providedwith a convex distal end 11 (see FIG. 1, showing a “bullet nose”) forease of insertion by the surgeon. Furthermore, as viewed in plan view inFIG. 2, cage 12 may also be provided with chamfers or cut outs 13 a, 13b on the distal end such that the cage 12 may be placed in anintervertebral space to avoid impinging on various structures in or nearthe vertebral body (such as the spinal foramina). Cage 12 may also beprovided with a curved end 15 of the posterior surface 14 (immediatelyopposite the oblique extension 17 described further herein). The curvedend 15 may also serve as a cut out to avoid impingement on the spinalforamina or other structures as the cage 12 is placed and/or as thesurgeon manipulates the cage 12 along or outside of the surgical pathwayP (see FIGS. 12 and 13, for example).

The cage 12 embodiments described herein may also comprise any numberand configurations of radiopaque markers (such as tantalum pins, notshown) for visualizing a position of the cage 12 using fluoroscopyduring insertion, manipulation and implantation. Such markers may beplaced obliquely in the distal end 11, in sidewalls of the cage adjacentthe anterior and posterior surfaces (16, 14, respectively), in aproximal end of the implant. Such markers may be placed parallel,oblique to and/or perpendicular to the anterior and posterior surfacesas required to properly visualize the position of the cage 12 relativeto the surgical pathway P and/or relative to a preferred oblique axis Oto facilitate preferred placement of plate 60 as described furtherherein.

Cage 12 includes a first vertebral engaging surface 18 and a secondvertebral engaging surface 20. Surfaces 18 may be substantially planarand configured to engage endplate tissue of a vertebral body, such as,for example, an endplate E1 of a V1 vertebral level, as shown in FIG.13. Surface 20 may be substantially planar and configured to engageendplate tissue of a vertebral body, such as, for example, an endplateE2 of a V2 vertebral level, as shown in FIG. 14. In some embodiments,surfaces 18, 20 may be rough, textured, porous, semi-porous, dimpled,knurled, toothed, grooved and/or polished such that it facilitatesengagement with tissue. Surfaces 18, 20 may also be at least partiallyconvex along the longitudinal axis L1 and/or at least partially convexin a direction substantially perpendicular to the longitudinal axis L2(i.e. from the anterior surface 16 to the posterior surface 14. In someembodiments, surfaces 18, 20 may be angled along the longitudinal axisL1 or angled perpendicular to the longitudinal axis L1 such thatanterior surface 16 is taller than posterior surface 14 such that thecage 12 may be capable of creating and/or augmenting lateral or lordoticcurvature in a human spine when implanted. In some embodiments, thevertebral tissue may include intervertebral tissue, endplate surfacesand/or cortical bone. In some embodiments, surfaces 18, 20 may be coatedwith materials suitable for facilitating or encouraging bony ongrowth orfusion including but not limited to titanium and hydroxyapatite (HA)coatings. In embodiments where titanium coatings are applied to surfaces18, 20, the titanium may be applied in a porous layer using plasma spraytechnology.

As shown in FIG. 2, Cage 12 may have a substantially rectangularconfiguration when viewed from above, and includes an inner surface 22and an outer surface 25. Surface 22 defines an opening 23 configured toreceive an agent, which may include bone graft (not shown) and/or othermaterials, as described herein, for employment in a fixation or fusiontreatment. In some embodiments, the plan geometry of cage 12 may havevarious configurations, such as, for example, oval, round, cylindrical,oblong, triangular, rectangular, polygonal having planar or arcuate sideportions, irregular, uniform, non-uniform, consistent, variable,horseshoe shape, U-shape or kidney bean shape (see FIG. 25 for example).

As shown in FIGS. 1 and 2, the cage 12 may comprise a corner extension17 such that the overall configuration of the cage when viewed fromabove is substantially asymmetrical about the longitudinal axis L1.Therefore, outer surface 25 at the corner extension 17 (i.e. anextension sidewall 44 a, as shown in FIG. 2), may define at least partof an oblique surface 44. The oblique surface 44 defines an elongatedopening, such as, for example, a track pathway 48. Oblique surface 44may extend along the corner extension 17 and proximal end of the cage 12such that at least a portion of the oblique surface may be insubstantial alignment with surgical pathway P, as shown in FIGS. 1 and2. Track pathway 48 is defined in oblique surface 44 and is incommunication with track 46 such that head 92 of connection mechanism 90may reside substantially in the track 46, and the post 94 of connectionmechanism 90 may extend outward through the track pathway 48 tofacilitate translation and/or rotation of a wall and/or plate, asdiscussed further herein. Track pathway 48 In one embodiment, as shownin FIG. 1, pathway 48 extends along an arc that is substantiallyparallel to the track 46 and to the oblique surface 44. In someembodiments, the track 46, surface 44 and/or track pathway 48 may bearcuate with a single radius defining the arcs. In other embodiments,the track 46, surface 44 and/or track pathway 44 may be arcuate withmultiple radii defining one or more of the individual arcs. In oneembodiment, oblique surface 44, track 46 (and the accompanying trackpathway 48 in communication with track 46) extends along a varyingradius of curvature. Track pathway 48 includes a first limit, such as,for example, a lateral axis limit 50, as shown in FIG.1, and a secondlimit, such as, for example, an oblique axis limit 52, as shown inFIG. 1. Limits 50, 52 provide a range of translation relative to cage 12along pathway 48, as discussed herein.

The term “oblique axis” O of the cage 12 body (see element O in FIGS. 1,11, 12, for example) as used herein may include any axis extendingoutward from the oblique surface of the cage 12 implant anywhere betweenthe lateral axis limit 50 and the oblique axis limit 52, including butnot limited to axes that are co-axial with longitudinal axis L1 and/orthe axis defined by surgical pathway P. As shown in FIGS. 14 and 15, atleast one of the various oblique axes O defined by the system 10 may besubstantially co-axial with the longitudinal axis L1 of cage 12.

In some embodiments, oblique surface 44, track 46 and track pathway 48may extend along a pathway having various configurations correspondingto the overall shape of the cage 12, such as, for example, round,cylindrical, oblong, triangular, rectangular, polygonal having planar orarcuate side portions, irregular, uniform, non-uniform, consistent,variable, horseshoe shape, U-shape or kidney bean shape. In someembodiments, surface 44 may be rough, textured, porous, semi-porous,dimpled, knurled, toothed, grooved and/or polished such that itfacilitates translation. In some embodiments, oblique surface 44 isconfigured for mating engagement with a surgical instrument, such as,for example, an inserter, which delivers cage 12 adjacent a surgicalsite via surgical pathway P, as described herein.

System 10 includes a wall, such as, for example, a plate 60 having asubstantially rectangular configuration. In some embodiments, plate 60can be variously configured, such as, for example, tubular, oval,oblong, triangular, square, polygonal, irregular, uniform, non-uniform,variable, hollow and/or tapered. Plate 60 includes a portion 62configured to engage a vertebral level V1 and a portion 64 configured toengage a vertebral level V2, as shown in FIG. 17. In one embodiment,plate 60 may be attached with cage 12 prior to implantation or in situ.Plate 60 includes a track engagement surface 66 and an instrumentengagement surface 68. Surface 66 defines an opening 67 configured toengage a connection mechanism to facilitate translation along pathway48. Surface 68 is configured to engage an instrument, such as, forexample, an inserter I to facilitate insertion of system 10.

Plate 60 includes an inner surface 70 that defines openings 72configured to receive fasteners 42, described herein. Openings 72 extendbetween surface 66 and surface 68. As shown generally in FIG. 25,fasteners 42 a are configured for fixation with vertebral level V1 andfasteners 42 b are configured for fixation with vertebral level V2. Insome embodiments, plate 60 includes a back out prevention element 74, asshown in FIG. 21.

Plate 60 includes a first surface 76 and a second surface 78. Surfaces76, 78 extend between an end 80 and an end 82. Surfaces 76, 78 mayinclude substantially planar portions that may be initially oriented ina first orientation such that surfaces 76, 78 are substantially inalignment with surfaces 18, 20 along axis L1 in a zero profile alignmentwith cage 12, as shown generally in FIG. 14. Surfaces 76, 78 may bemanipulated to a second orientation, as shown in FIG. 17, such thatsurfaces 76, 78 are transverse to surfaces 18, 20 and axis L1. FIGS.14-17 show an exemplary transition of the plate 60 from the firstorientation to the second orientation. Plate 60 may also be translatablealong track 46 and track pathway 48 about axis L2 of the patient body(defined generally, for example, by a longitudinal axis of the spinalcolumn) and is also rotatable about an oblique axis O of cage 12, asshown in FIG. 15 (with the understanding that the oblique axis O may be,in some configurations substantially co-axial with the longitudinal axisL1). Surface 44 facilitates translation of plate 60 relative to cage 12.This configuration provides selective positioning of plate 60 withrespect to a patient's body for adapting to the configuration of thetissue surfaces of vertebrae, as well as provide range of motion limits50, 52 for plate 60.

Surgical system 10 includes a connection mechanism 90 configured toconnect plate 60 with track 46. In one embodiment, as shown in FIGS. 2and 3, mechanism 90 includes a connecting member, such as, for example,a head 92 having an elongated post 94. Head 92 is configured forengagement with and translation along track 46. Post 94 is configuredfor disposal in opening 67 of plate 60. A nut 96 is configured to lockthe head 92 (which may comprise the distal end of a bolt) with plate 60such that translation of head 92 along track 46 causes plate 60 totranslate along surface 44 of cage 12. In some embodiments, a dovetailor t-slot sliding attachment mechanism can be utilized. In someembodiments, plate 60 can be freely translatable in situ within thepatient body such that plate 60 is configured for dynamic translation.In some embodiments, plate 60 can be positioned within the patient bodyand locked into a fixed position.

Spinal implant system 10 includes one or more fasteners 42, such as, forexample, as shown in FIG. 21, for attaching plate 60 to bone, asdescribed herein. In some embodiments, fasteners 42 a and 42 b may beengaged with tissue, such as, for example, the bony structures of avertebral body in various orientations, such as, for example, series,parallel, offset, staggered and/or alternate vertebral levels. In someembodiments, one or more of fasteners 42 may comprise multi-axialscrews, sagittal angulation screws, pedicle screws, mono-axial screws,uni-planar screws, facet screws, fixed screws, tissue penetratingscrews, conventional screws, expanding screws, wedges, anchors, buttons,clips, snaps, friction fittings, compressive fittings, expanding rivets,staples, nails, adhesives, posts, fixation plates and/or posts.

Fastener 42 comprises a first portion, such as, for example, a head 43and a second portion, such as, for example, an elongated shaft 45configured for penetrating tissue. Head 43 includes an engagementportion configured for engagement with a surgical instrument. Shaft 45has a cylindrical cross section configuration and includes an outersurface having an external thread form. In some embodiments, theexternal thread form may include a single thread turn or a plurality ofdiscrete threads. In some embodiments, other engaging structures may belocated on shaft 45, such as, for example, nail configuration, barbs,expanding elements, raised elements and/or spikes to facilitateengagement of shaft 45 with tissue, such as, for example, vertebrae.

In some embodiments, all or only a portion of shaft 45 may havealternate cross section configurations, such as, for example, oval,oblong, triangular, square, polygonal, irregular, uniform, non-uniform,offset, staggered, undulating, arcuate, variable and/or tapered. In someembodiments, the outer surface of shaft 45 may include one or aplurality of openings. In some embodiments, all or only a portion of theouter surface of shaft 45 may have alternate surface configurations,such as, for example, smooth and/or surface configurations to enhancefixation with tissue, such as, for example, rough, arcuate, undulating,porous, semi-porous, dimpled, polished and/or textured. In someembodiments, all or only a portion of shaft 45 may be cannulated.

In some embodiments, system 10 may comprise various surgicalinstruments, such as, for example, drivers, extenders, reducers,spreaders, distractors, blades, clamps, forceps, elevators and drills,which may be alternately sized and dimensioned, and arranged as a kit.In some embodiments, system 10 may comprise the use of microsurgical andimage guided technologies, such as, for example, surgical navigationcomponents employing emitters and sensors, which may be employed totrack introduction and/or delivery of the components of system 10including the surgical instruments to a surgical site. See, for example,the surgical navigation components and their use as described in U.S.Pat. Nos. 6,021,343, 6,725,080, 6,796,988, the entire contents of eachof these references being incorporated by reference herein.

In one embodiment, as shown in in FIGS. 4-6, system 10, similar to thesystems and methods described herein, comprises a spinal constructincluding cage 12, described above, and a plate 160, similar to plate 60described with regard to FIGS. 1-3. Outer surface 125 (or sidewall) ofcage 12 includes an oblique surface 144 that defines an elongatedopening, such as, for example, a track pathway 148. Oblique surface 144is oriented with cage 12 and in substantial alignment with surgicalpathway P. Track 146 is in open communication with surface 144 to definea track pathway 148 that facilitates engagement with and translation ofplate 160. Pathway 148 extends about a longitudinal axis L2 of thepatient body (wherein L2 is defined generally by the length of thepatient's spine), shown as a point L2 in FIG. 4. Pathway 148 includes alateral axis limit 150, as shown in FIG. 5, and an oblique axis limit152, as shown in FIG. 5. Limits 150, 152 provide a range of translationrelative to cage 12 along pathway 148, as discussed herein.

Plate 160 includes a portion 162 configured to engage a vertebral leveland a portion 164 configured to engage a second vertebral level. Plate160 includes a track engagement surface 166 and an instrument engagementsurface 168. Surface 166 defines an opening 167 configured to engage aconnection mechanism to facilitate translation along pathway 148.Surface 168 is configured to engage an instrument to facilitateinsertion of system 10. Surface 144 provides range of motion limits 150,152 for plate 160 for selective positioning of plate 160 to adapt tovertebrae.

Plate 160 includes an inner surface 170 that defines openings 172configured to receive fasteners 42, described herein. Openings 172extend between surface 166 and surface 168. A connection mechanism 190is configured to connect plate 160 with track 146. Mechanism 190includes a spheroidal joint, such as, for example, a ball screw 192having an elongated post 194. Screw 192 is configured to provide freedomof movement and/or toggle of plate 160 relative to cage 112. Screw 192is configured for engagement with and translation along track 146. Post194 is configured for disposal with opening 167 of plate 160. A nut 196is configured to lock screw 192 with plate 160 such that translation ofscrew 192 along track 146 causes plate 160 to translate along surface144 of cage 12. Screw 192 provides translation and rotation of plate 160relative to cage 112 in a plurality of axial orientations and inmultiple planes. As shown in FIGS. 4 and 6, complementary surfaces 144and 166 may be arcuate in multiple planes such that the plate 160 may bearticulated polyaxially relative to the cage 12.

In assembly, operation and use, as shown in FIGS. 7-22, spinal implantsystem 10, similar to the systems described herein, is employed with asurgical procedure for treatment of a spinal disorder, such as thosedescribed herein, affecting a section of a spine of a patient. System 10may also be employed with other surgical procedures. To treat theaffected section of vertebrae V of a patient utilizing an OLIF and DLIFprocedure. In some embodiments, system 10 may include retractors suchthat no further probe is required. In some embodiments, system 10 mayinclude retractors constrained via frame or semi-constrained usingelastic or partial frame.

In some embodiments, as shown in FIGS. 10-13, a surgical instrument,such as, for example, a retractor T2 is disposed in communication withsurgical pathway P for spacing tissue, as shown in FIG. 10. Retractorblades b1, b2 are inserted simultaneously as part of a unitary retractorinstrument around one or more intervertebral spaces to protect vessels.The various embodiments of the cage 12 and plate 60 disclosed herein mayallow a surgeon to more effectively manipulate the plate 60 and cage 12construct relative to the retractor T2. For example, as shown in FIGS.10-13, the inserter I, cage 12, and plate 60 may be inserted along thesurgical pathway P substantially between the blades b1, b2 of theretractor T2 with the plate 60 oriented in a low or zero-profileconfiguration (see FIG. 14, for example). The surgeon may be free torotate the inserter I (and consequently the cage 12) into positionrelative to the vertebrae V1 and V2 and outside the extents of theblades b1 , b2 (see FIG. 13) with the plate 60 in the low-profileconfiguration. After positioning the cage 12, the surgeon may thenutilize the inserter to rotate the plate 60 into position about theoblique axis O defined by the position of the plate 60 relative to thecage 12 in order to obtain a preferred position of the plate 60 relativeto vertebrae V1, V2.

In some embodiments, an annulotomy and/or discectomy is performed with asurgical instrument with x-ray confirmation of the starting point thatis central on one or more intervertebral spaces. In some embodiments,system 10 includes a semi-constrained retractor that facilitates minimaltissue pressures on surrounding abdominal structures and providesflexibility such that its blades rotate on a fixed pin allowing greaterdegrees of freedom of movement and working angles for a practitioner.

A probe is passed into the disc space to secure its location. In oneembodiment, the oblique angle and lordotic angle of the probe as itenters the disc space is assessed preoperatively and measuredintraoperative using image guidance or using a mechanical or digitalprotractor. Fluoroscopy, image guidance and/or surgical navigation, asdescribed herein, are used to confirm proper probe alignment into thedisc space. In some embodiments, a guide wire is placed through acannula into the disc space and positioning is confirmed withfluoroscopy. Instruments, such as, for example, a Cobb, mallet, shaver,serrated curettes, rasp, a ring curette, a uterine curette and/or combotools are utilized to perform a discectomy of the disc space. Theinstruments enter the patient body obliquely through the retractor andcan be turned orthogonally to allow the surgeon to work orthogonallyacross the disc space. The disc space is distracted until adequate discspace height is obtained.

In some embodiments, a discectomy is performed via surgical pathway P.In some embodiments, trial implants are delivered along surgical pathwayP and used to distract one or more intervertebral spaces and applyappropriate tension in the intervertebral space allowing for indirectdecompression. In one embodiment, a direct decompression of the discspace is performed by removing a portion of a herniated disc. In someembodiments, the size of cage 12 is selected after trialing, cage 12 isvisualized by fluoroscopy and oriented before malleting intointervertebral space. Trialing is utilized to establish a starting pointfor cage 12 insertion. In some embodiments, an anterior longitudinalligament (ALL) release procedure can be performed using an OLIF or aDLIF approach post-discectomy. For example, loosening the ALL can beperformed by placing holes or partial cuts in the ALL such that the OLIFsurgical pathway is immediately closer to the ALL.

Pilot holes or the like are made in selected vertebra V1, V2 ofvertebrae V adjacent the intervertebral space, via surgical pathway P,for receiving bone fasteners 42 a, 42 b. As shown in FIGS. 7 and 8,inserter I is attached with cage 12 and/or plate 60. Inserter I deliverscage 12 and plate 60 along surgical pathway P adjacent to a surgicalsite for implantation adjacent the intervertebral space between V1 andV2. In one embodiment, inserter I includes a navigation components tofacilitate placement of cage 12 and plate 60 between vertebrae V1, V2.In some embodiments, system 10 may comprise various surgicalinstruments, such as, for example, drivers, extenders, reducers,spreaders, distractors, blades, clamps, forceps, elevators and drills,which may be alternately sized and dimensioned, and arranged as a kit.In some embodiments, system 10 may comprise various surgicalinstruments, such as, for example, drivers, extenders, reducers,spreaders, distractors, blades, clamps, forceps, elevators and drills,which may be alternately sized and dimensioned, and arranged as a kit.In some embodiments, system 10 may comprise the use of microsurgical andimage guided technologies, such as, for example, surgical navigationcomponents employing emitters and sensors, which may be employed totrack introduction and/or delivery of the components of system 10including the surgical instruments to a surgical site. See, for example,the surgical navigation components and their use as described in U.S.Pat. Nos. 6,021,343, 6,725,080, 6,796,988, the entire contents of eachof these references being incorporated by reference herein.

During insertion, plate 60 can be disposed such that surfaces 76, 78 aresubstantially perpendicular to surface 44 (FIG. 7) or surfaces 76, 78are substantially aligned with surfaces 18, 20 forming a zero profileimplant (FIG. 8). A pivot bolt 98 is utilized to provisionally fix plate60 and cage 12 with inserter I. Tightening of bolt 98 causes cage 12,plate 60 and inserter I to be drawn together and held in a fixedorientation during insertion. Cage 12 and plate 60 are inserted throughretractor T2 adjacent the surgical site. Anterior surface 16 faces ananterior side of the patient body adjacent anterior portion A1 andposterior surface 14 faces a posterior side of the patient body adjacentposterior portion P1, as described herein with respect to FIGS. 11 and12. Surface 18 engages endplate tissue of endplate E1 and surface 20engages endplate tissue of endplate E2. In some embodiments, afterimplantation of cage 12 and plate 60, a practitioner can loosen theconnection of inserter I, cage 12 and plate 60. This configurationallows plate 60 to rotate and/or translate relative to cage 12, whichprovides cage 12 and plate 60 relative freedom of movement such that thepractitioner can maneuver the spinal construct for final placement ofcage 12 and/or plate 60.

Inserter I is an adaptable instrument configured to perform multipleapplications during a surgical procedure. In some embodiments, inserterI can prepare and/or create a cavity in tissue, such as, for example,bone. Inserter I guides a surgical instrument, such as, for example, adrill, tap and/or an awl, as well as guiding fasteners to penetratetissue. In some embodiments, inserter I is a guide that holds plate 60and cage 12 together. Surgical instruments including an awl, a tap andscrews are passed through inserter I.

In one embodiment, inserter I is utilized to apply a force to plate 60such that plate 60 is translatable along track 46, as shown by arrows Cin FIGS. 2 and 3. In one embodiment, as shown in FIG. 11, plate 60 ispositioned at an oblique angle relative to cage 12, prior to rotation ofplate 60. In one embodiment, as shown in FIG. 12, plate 60 is translatedalong track 46 to a position laterally disposed relative to cage 12,prior to rotation and positioning of plate 60. Plate 60 is translatedbetween lateral axis limit 50 and oblique axis limit 52 to facilitateproper positioning of plate 60 relative to cage 12.

As shown in FIGS. 14-18, plate 60 is rotated into position such thatportion 62 is oriented to engage vertebra V1 and portion 64 isconfigured to engage vertebra V2. Rotation of plate 60 in situfacilitates insertion due to a low profile configuration of cage 12 andplate 60 during insertion. Translation and rotation of plate 60 allowsselective manipulation of plate 60 to facilitate plate 60 adapting withvertebrae. Fasteners 42 a, 42 b are inserted along inserter I via adriver D through openings 72 such that fastener 42 a engages vertebra V1and fastener 42 b engages vertebra V2. Driver D is disposed adjacent theintervertebral space and is manipulated to drive, torque, insert orotherwise connect bone fasteners 42 a, 42 b adjacent the intervertebralspace. In some embodiments, the driver may include surgical navigationcomponents, as described herein, to establish a screw pathway that issubstantially concurrent with and/or parallel to the surgical approachangle. In one embodiment, as shown in FIGS. 19 and 21, plate 60 is fixedwith fasteners 42 a, 42 b at an oblique angle relative to cage 12. Inone embodiment, as shown in FIG. 20, plate 60 is fixed with fasteners 42a, 42 b laterally to cage 12. In one embodiment, as shown in FIG. 22,plate 60 includes a back out prevention element 74 that is rotated toprevent fasteners 42, 42 b from disengaging from vertebrae V1, V2.

Upon completion of a procedure, as described herein, the surgicalinstruments, assemblies and non-implanted components of spinal implantsystem 10 are removed and the incision(s) are closed. One or more of thecomponents of spinal implant system 10 can be made of radiolucentmaterials such as polymers. Radiopaque markers may be included foridentification under x-ray, fluoroscopy, CT or other imaging techniques.In some embodiments, the use of surgical navigation, microsurgical andimage guided technologies may be employed to access, view and repairspinal deterioration or damage, with the aid of spinal implant system10. In some embodiments, spinal implant system 10 may include one or aplurality of plates, connectors and/or bone fasteners for use with asingle vertebral level or a plurality of vertebral levels.

In one embodiment, spinal implant system 10 includes an agent, which maybe disposed, packed, coated or layered within, on or about thecomponents and/or surfaces of spinal implant system 10. In someembodiments, the agent may include bone growth promoting material, suchas, for example, bone graft to enhance fixation of the components and/orsurfaces of spinal implant system 10 with vertebrae. In someembodiments, the agent may include one or a plurality of therapeuticagents and/or pharmacological agents for release, including sustainedrelease, to treat, for example, pain, inflammation and degeneration.

In one embodiment, as shown in FIGS. 23-25, system 10, similar to thesystems and methods described herein, comprises a spinal constructincluding cage 212, similar to cage 12, described above, and a plate260, similar to plate 60 described above. Cage 212 extends between aposterior surface 214 and an anterior surface 216. Cage 212 includes afirst vertebral engaging surface 218 and a second vertebral engagingsurface 220. Surface 218 may be substantially planar and configured toengage endplate tissue of a vertebral body, such as, for example, anendplate of a vertebral level (not shown, but may be immediately caudalto the vertebral body V2 shown in FIG. 25). Surface 220 may besubstantially planar and configured to engage endplate tissue of avertebral body, such as, for example, an endplate E2 of a V2 vertebrallevel, as shown in FIG. 25. The surfaces 218, 220 may also be providedwith convex portions and/or inclined portions to provide for lordoticcorrection and/or to better conform to the anatomy of particularvertebral endplates.

In the embodiments of FIGS. 23-25, cage 212 has a substantially kidneybean shaped cross section configuration (such as that which may be usedin an anterior and/or anterior-oblique spinal approach) and includes aninner surface 222 and an outer surface 225. Surface 222 defines anopening 223 configured to receive an agent, which may include bone graft(not shown) and/or other materials, as described herein, for employmentin a fixation or fusion treatment. Outer surface 225 includes anelliptical oblique surface 244 that defines a track 246. Track 246 is inopen communication with surface 244 to define a track pathway 248 thatfacilitates connection with and translation of plate 260. In oneembodiment, as shown in FIG. 23, pathway 248 is arcuate in shape.Pathway 248 includes a lateral axis limit 250 and an oblique axis limit252. Limits 250, 252 provide a range of translation relative to cage212, as discussed herein.

System 10 includes plate 260 having a substantially rectangularconfiguration. Plate 260 includes a portion 262 configured to engage avertebral level V1 and a portion 264 configured to engage a vertebrallevel V2. Plate 260 includes a track engagement surface 266 and aninstrument engagement surface 268. Surface 266 defines an opening 267configured to engage a connection mechanism 290 to facilitatetranslation along pathway 248. Surface 268 is configured to engage aninserter (not shown) to facilitate insertion of system 10. As shown inthe plan view of FIG. 23, surfaces 266, 268 may be arcuate in shape suchthat plate 260 conforms to edge 244 of cage 212.

Plate 260 includes an inner surface 270 that defines openings 272configured to receive fasteners 42, described herein. Openings 272extend between surface 266 and surface 268. Fasteners 42 a (not shown)are configured for fixation with vertebral level V1 and fasteners 42 bare configured for fixation with vertebral level V2. In one embodiment,fasteners 42 are aligned to engage vertebrae in a straight orientation.In some embodiments, fasteners 42 are configured to engage vertebrae atan angled orientation.

Plate 260 includes a first surface 276 and a second surface 278.Surfaces 276, 278 extend between an end 280 and an end 282. Plate 260 istranslatable, as shown by arrows D in FIG. 23, about pathway 248 aboutan axis L2 of the patient body and rotatable about surface 244 about anoblique axis O2 of cage 212. The term “oblique axis” O2 (see element O2in FIG. 23, for example) as used herein may include any axis extendingoutward from the oblique surface anywhere between the lateral axis limit250 and the oblique axis limit 252.

As shown in FIG. 23, connection mechanism 290 includes a bolt 292 havingan elongated post 294. Bolt 292 is configured for translation alongtrack 246. Post 294 is configured to engage opening 267 of plate 260. Anut 296 is configured to lock bolt 292 with plate 260 such thattranslation of bolt 292 along track 246 causes plate 260 to translatealong surface 244 of cage 212. It should be understood that thepositioning of the nut 296 and bolt 292 may be reversed in variousembodiments as necessary.

In one embodiment, as shown in FIG. 23, plate 260 is translated alongtrack 246 to a position relative to cage 212, prior to rotation andpositioning of plate 260. Plate 260 is translated between lateral axislimit 250 and oblique axis limit 252 to facilitate proper positioning ofplate 260 relative to cage 212. Plate 260 is rotated into position asshown by arrows E in FIG. 24, such that portion 262 is oriented toengage vertebra V1 and portion 264 is configured to engage vertebra V2.Rotation of plate 260 in situ facilitates insertion due to a low profileconfiguration of cage 212 and plate 260 during insertion. Translationand rotation of plate 260 allows selective manipulation of plate 260 tofacilitate a proper fit with vertebrae.

In one embodiment, as shown in FIGS. 26-27, system 10, similar to thesystems and methods described herein, comprises a spinal constructincluding cage 312, similar to cage 12, described above, and a plate360, similar to plate 60 described above. Cage 312 includes a firstvertebral engaging surface 318 and a second vertebral engaging surface320. Surface 318 is substantially planar and configured to engageendplate tissue E1 of a V1 vertebral level, as shown in FIG. 27. Surface320 is configured to engage endplate tissue E2 of a V2 vertebral level,as shown in FIG. 27. It should be noted that the embodiment of FIGS.26-27 may be especially useful in lumbo-sacral fusion of the L5-S1 level(wherein V2 is FIG. 27 refers to the sacrum).

Cage 312 may have a substantially rectangular cross sectionconfiguration and an outer surface 325. Outer surface 325 includes anarcuate oblique surface 344 that defines a track 346. Track 346 is inopen communication with surface 344 to define a track pathway 348 thatfacilitates engagement with and translation of plate 360.

As shown in FIG. 26, plate 360 includes a substantially triangularconfiguration. Plate 360 includes a portion 362 configured to engage avertebral level V1 and a portion 364 configured to engage a vertebrallevel V2. Plate 360 includes a track engagement surface 366 and aninstrument engagement surface 368. Cage 312 and plate 360 are configuredto connect with a connection mechanism 390, as discussed herein. Plate360 includes an inner surface 370 that defines openings 372 configuredto receive fasteners 42, not shown. In one embodiment, openings 372 aredisposed at angles of approximately 30 degrees relative to plate 360 tofacilitate engagement with vertebrae.

In one embodiment, as shown in FIG. 27, plate 360 is translated alongtrack 346 to a position relative to cage 312, prior to rotation andpositioning of plate 360. Plate 360 is translated between lateral axislimit 350 and oblique axis limit 352 to facilitate selective positioningof plate 360 relative to cage 312. Plate 360 is rotated into position asshown by arrows F in FIG. 24, such that portion 362 is oriented toengage vertebra V1 and portion 364 is configured to engage vertebra V2.Rotation of plate 360 in situ facilitates insertion due to a low profileconfiguration of cage 312 and plate 360 during insertion. Translationand rotation of plate 360 allows for selective manipulation of plate 360to facilitate adaption of plate 360 with vertebrae.

In one embodiment, as shown in FIGS. 28A-28D, system 10, similar to thesystems and methods described herein, comprises a spinal constructincluding cage 412, similar to cage 12, described above, and a plate460, similar to plate 60 described above. As shown in FIGS. 28A-28D,system 10 includes a multilevel system having cages 412, 412′ and plates460, 460′. Cage 412, 412′ extends between a posterior surface 414, 414′and an anterior surface 416, 416′. Cage 412, 412′ includes a firstvertebral engaging surface 418, 418′ and a second vertebral engagingsurface 420, 420′. Surface 418, 418′ is substantially planar andconfigured to engage endplates E1, E3. Surface 420, 420′ is configuredto engage endplates E2, E4.

Cage 412, 412′ includes an outer surface 425, 425′ having and obliquesurface 444, 444′ that defines a track 446, 446′. Track 446, 446′ is inopen communication with surface 444, 444′ to define a track pathway 448,448′ that facilitates engagement with and translation of plate 460,460′. As shown in FIGS. 28A-28D, plate 460, 460′ includes a portion 462,462′ configured to engage a vertebral level V1, V2 and a portion 464,464′ configured to engage a second vertebral level V2, V3. Plate 460,460′ includes a track engagement surface 466, 466′ and an instrumentengagement surface 468, 468′. Surface 466, 466′ defines an opening 467,467′ configured to engage connection mechanism 490, 490′ to facilitatetranslation and rotation of plate 460, 460′ along pathway 448, 448′.

Plate 460, 460′ includes an inner surface 470, 470′ that definesopenings 472, 474′ configured to receive fasteners 42, described herein.Fasteners 42 a (not shown) are configured for fixation with a vertebrallevel V1, V2 and fasteners 42 b are configured for fixation withvertebral level V2, V3.

In one embodiment, as shown in FIGS. 28A-28D, plate 460, 460′ istranslated along track 446 to a position relative to cage 412, prior torotation and positioning of plate 460, 460′. Plate 460, 460′ istranslated between lateral axis limit 450, 450′ and oblique axis limit452, 452′ to facilitate selective positioning of plate 460, 460′relative to cage 412, 412′. Plate 460, 460′ is rotated into position toengage vertebrae. Rotation of plate 460, 460′ in situ facilitatesinsertion due to a low profile configuration of cage 412, 412′ and plate460, 460′ during insertion. Translation and rotation of plate 460, 460′allows for selective manipulation of plate 460, 460′ to facilitateadaption of plate 460, 460′ with vertebrae.

As shown in FIGS. 28A-28D, plate 460, 460′ includes a threaded post 502,502′ configured to receive a plate 504. In one embodiment, posts 502,502′ have multi-axial pivoting to facilitate engagement with plate 504.Plate 504 includes an engagement surface 506 and an inner surface 508.Surface 506 is configured to engage plates 460, 460′. In someembodiments, all or only a portion of the surface 506 may have alternatesurface configurations, such as, for example, smooth and/or surfaceconfigurations to enhance fixation with tissue, such as, for example,rough, arcuate, undulating, porous, semi-porous, dimpled, polishedand/or textured to enhance engagement. Surface 508 defines openings 510configured to receive posts 502, 502′. In one embodiment, openings 510are elongated to facilitate positioning of plate 504 over posts 502,502′. Locking nuts 512, 512′ are provided to lock plate 504 in a fixedposition with plates 460, 460′. Plate 504 is configured to providestability to system 10 when engaged with vertebrae V.

In one embodiment, as shown in FIGS. 29-32, system 10, similar to thesystems and methods described herein, comprises a spinal constructincluding cage 612, similar to cage 12, described above, and a plate660, similar to plate 60 described above. As shown in FIG. 29, system 10includes two plates 660, 660′. Cage 612 extends between a posteriorsurface 614 and an anterior surface 616. Cage 612 includes a firstvertebral engaging surface 618 and a second vertebral engaging surface620. Surface 618 is substantially planar and configured to engageendplate tissue of a vertebral body, such as, for example, an endplateE1 of a V1 vertebral level, as shown in FIG. 30. Surface 620 isconfigured to engage endplate tissue of a vertebral body, such as, forexample, an endplate E2 of a V2 vertebral level, as shown in FIG. 30.

Cage 612 may have a substantially rectangular cross sectionconfiguration and includes an outer surface 625. Outer surface 625includes an arcuate oblique surface 644 that defines a track 646. Track646 is in open communication with surface 644 to define a track pathway648 that facilitates translation and rotation of plates 660, 660′.Pathway 648 includes a lateral axis limit 650 and an oblique axis limit652. Limits 650, 652 provide a range of translation.

As shown in FIG. 29, system 10 includes a first plate 660 and a secondplate 660′ each having a substantially rectangular configuration. Plate660, 660′ includes a portion 662, 662′ configured to engage a vertebrallevel V1 and a portion 664, 664′ configured to engage a vertebral levelV2. Plate 660, 660′ includes a track engagement surface 666, 666′ and aninstrument engagement surface 668, 668′. Surface 666, 666′ defines anopening 667, 667′ configured to engage connection mechanism 690 (hidden)to facilitate translation along pathway 648. Surface 666, 666′ define anindent 700, 700′ configured to engage each other such that plates 660,660′ are in a nesting configuration upon a cruciate positioning withvertebrae.

Plate 660, 660′ includes an inner surface 670, 670′ that definesopenings 672, 672′ configured to receive fasteners 42, described herein.Fasteners 42 a are configured for fixation with vertebral level V1 andfasteners 42 b are configured for fixation with vertebral level V2.

Plate 660, 660′ includes a first surface 676, 676′ and a second surface678, 678′. Upon insertion, plates 660, 660′ are collapsed, as shown inFIGS. 31A, 31B and 32A, 32B such that surfaces 676, 676′ and 678, 678′are in a parallel orientation forming a low or zero profile plateconfiguration. Upon insertion, plates 660, 660′ are rotated such thatsurfaces 676, 676′ and 678, 678′ are positioned in a transverseorientation to engage vertebrae V1, V2. The surfaces 676, 676′ maydefine locking channels 700, 700′ that may interact and/or be nested tolock in place when the surfaces 676, 676′ and 678, 678′ are positionedin a transverse orientation to engage vertebrae V1, V2 (as shown, forexample in FIGS. 32A-32B).

In one embodiment, as shown in FIG. 29, plate 660, 660′ is translatedalong track 646 to a position relative to cage 612, prior to rotationand positioning of plate 660, 660′. Plate 660, 660′ is translatedbetween lateral axis limit 650, 650′ and oblique axis limit 652, 652′ tofacilitate selective positioning of plate 660, 660′ relative to cage612. Plate 660, 660′ is rotated into position to engage vertebrae.Rotation of plate 660, 660′ in situ facilitates insertion due to a lowprofile configuration of cage 612′ and plate 660, 660′ during insertion.Translation and rotation of plate 660, 660′ allows for selectivemanipulation of plate 660, 660′ to facilitate adaption of plate 660,660′ with vertebrae.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as exemplification of thevarious embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

1-18. (canceled)
 19. A method for treating a spine, the methodcomprising the steps of: providing a spinal implant including an implantbody extending between an anterior surface and a posterior surface, andincluding an oblique surface; providing a wall of the spinal implanthaving a first portion and a second portion; connecting the wall withthe implant body such that the wall is disposed in a zero profilealignment with the implant body; delivering the spinal implant adjacenta first vertebra and a second vertebra; and selectively rotating and/ortranslating the wall relative to the oblique surface such that the firstportion is aligned with the first vertebra and the second portion isaligned with the second vertebra.
 20. A method as recited in claim 19,wherein the oblique surface defines an opening configured for disposalof the wall, the opening defining a range of movement of the wall forthe selective translation between a lateral axis and an oblique axis ofthe implant body.
 21. A method as recited in claim 19, whereinselectively rotating and/or translating the wall relative to the obliquesurface comprises rotating the wall about a connection mechanism havinga head that is disposed in an opening in the oblique surface and a shaftthat extends through an opening in the wall.
 22. A method as recited inclaim 21, wherein the shaft extends through opposite inner and outersurfaces of the wall.
 23. A method as recited in claim 21, wherein thehead is spheroidal.
 24. A method as recited in claim 21, wherein theopening has an oblong shape.
 25. A method as recited in claim 19,further comprising inserting fasteners through holes in the first andsecond portions and into the first and second vertebrae.
 26. A method asrecited in claim 25, further comprising rotating a back out preventionelement that is rotatable relative to the wall from a first orientationin which arms of the back out prevention element are spaced apart fromthe fasteners to a second orientation in which the arms overlap thefasteners to prevent the fasteners from backing out of the holes.
 27. Amethod as recited in claim 19, wherein: connecting the wall with theimplant body comprises inserting a head of a connection mechanism into atrack in the oblique surface such that a shaft of the connecting memberextends through the wall; and the method further comprises translatingthe connection member with the head positioned within the track suchthat the plate moves relative to the implant body and toward theanterior surface.
 28. A method as recited in claim 19, wherein:connecting the wall with the implant body comprises inserting a head ofa connection mechanism into a track in the oblique surface such that ashaft of the connecting member extends through the wall; and the methodfurther comprises translating the connection member with the headpositioned within the track such that the plate moves relative to theimplant body and toward the posterior surface.
 29. A method as recitedin claim 19, wherein delivering the spinal implant adjacent to the firstand second vertebrae comprises engaging opposite first and secondsurfaces of the implant body with the first and second vertebrae, thefirst and second surfaces being angled such that the anterior surface istaller than the posterior surface.
 30. A method for treating a spine,the method comprising the steps of: positioning an implant body of aspinal implant such that top and bottom surfaces of the implant bodyengage adjacent first and second vertebrae, the implant body extendingbetween an anterior surface and a posterior surface, the implant bodyincluding an oblique surface that extends between the anterior andposterior surfaces and between the top and bottom surfaces, the implantbody comprising a wall of the spinal implant connected thereto such thataxes defined by holes that extend through the plate intersect theimplant body; and selectively rotating the wall relative to the obliquesurface such that one of the axes intersects the first vertebra andanother one of the axes intersects the second vertebra.
 31. A method asrecited in claim 30, wherein selectively rotating the wall relative tothe oblique surface comprises rotating the wall about a connectionmechanism having a head that is disposed in an opening in the obliquesurface and a shaft that extends through an opening in the wall.
 32. Amethod as recited in claim 31, wherein; the opening in the obliquesurface defines a range of movement of the wall for the selectivetranslation between a lateral axis limit and an oblique axis limit ofthe implant body; and the method further comprises translating the wallrelative to the implant body toward the lateral axis limit.
 33. A methodas recited in claim 31, wherein: the opening in the oblique surfacedefines a range of movement of the wall for the selective translationbetween a lateral axis limit and an oblique axis limit of the implantbody; and the method further comprises translating the wall relative tothe implant body toward the oblique axis limit.
 34. A method as recitedin claim 31, wherein the head is spheroidal.
 35. A method as recited inclaim 31, wherein the opening in the oblique has an oblong shape.
 36. Amethod as recited in claim 30, further comprising inserting fastenersthrough holes in the first and second portions and into the first andsecond vertebrae after selectively rotating the wall relative to theoblique surface.
 37. A method as recited in claim 36, further comprisingrotating a back out prevention element that is rotatable relative to thewall from a first orientation in which arms of the back out preventionelement are spaced apart from the fasteners to a second orientation inwhich the arms overlap the fasteners to prevent the fasteners frombacking out of the holes.
 38. A method for treating a spine, the methodcomprising the steps of: positioning an implant body of a spinal implantsuch that top and bottom surfaces of the implant body engage adjacentfirst and second vertebrae, the implant body extending between ananterior surface and a posterior surface, the implant body including anoblique surface that extends between the anterior and posterior surfacesand between the top and bottom surfaces, the implant body comprising awall of the spinal implant connected thereto such that axes defined byholes that extend through the plate intersect the implant body; andselectively rotating the wall relative to the oblique surface byrotating the wall about a connection mechanism having a spheroidal headthat is disposed in an oblong opening in the oblique surface and a shaftthat extends through an opening in the wall, the wall being selectivelyrotated such that one of the axes intersects the first vertebra andanother one of the axes intersects the second vertebra; insertingfasteners through holes in the first and second portions and into thefirst and second vertebrae after selectively rotating the wall relativeto the oblique surface; and rotating a back out prevention element thatis rotatable relative to the wall from a first orientation in which armsof the back out prevention element are spaced apart from the fastenersto a second orientation in which the arms overlap the fasteners toprevent the fasteners from backing out of the holes, wherein the openingin the oblique surface defines a range of movement of the wall for theselective translation between a lateral axis limit and an oblique axislimit of the implant body, and wherein the method further comprisestranslating the wall relative to the implant body toward the lateralaxis limit or the oblique axis limit.